Mr Justice Richard Humphreys recently delivered judgement concerning a prisoner’s right to autonomy and in particular the right to refuse medical treatment. In ordering the medical treatment Justice Humphreys found a prisoner in custody under a court order is not entitled to refuse treatment where this would directly or ultimately put his life at risk and thereby frustrate the verdict or order of the court. To that extent, the prisoner’s rights to autonomy, privacy and bodily integrity are qualified by his status as a prisoner.
By way of background the defendant prisoner was serving a life sentence and was admitted to hospital with a self-inflicted injury to his neck. The defendant refused medical treatment and surgical intervention. The hospital was of the view that he required “immediate and continuing intra-venous antibiotic administration to reduce the immediate possibility of sepsis in his present condition”.
An application was then made for an interlocutory order authorising the hospital to administer all necessary medical and surgical treatment to protect the defendant’s bodily integrity. In allowing the order, Justice Humphreys considered the defendant’s capacity to reject the medical treatment, as well as his rights to bodily integrity and autonomy.
In relation to capacity, the court looked at the opinion of the Senior Registrar, based on her interview with the defendant. She asserted that “it was difficult to assess the full extent of his psychotic phenomena given limited engagement with the interview”. It was stated that the defendant was dismissive of medical advice and in denial of the reality of his situation. Justice Humphreys was conscious that this does not necessarily mean mental illness and stressed the distinction between not wanting to be treated, and not understanding the nature and consequences of the treatment. Thus he concluded on the matter of capacity that if the matter hinged on its being clear that the defendant lacked capacity further evidence would be required before proceeding with the order.
Justice Humphreys then considered whether a prisoner enjoys a right to autonomy to refuse necessary treatment. Whilst suicide is not a crime, Justice Humphreys noted it is not a lawful act and is against public policy. Generally speaking however, a mentally competent adult is entitled to kill him or herself indirectly, e.g. by refusing food etc., which is a right seen as flowing from the right to autonomy and bodily integrity. Referring to American jurisprudence, the Court made the distinction between a prisoner’s right to bodily integrity on the one hand, and right to autonomy on the other. The former involves his or her right not to be harmed or neglected by the State. However, it is held that a prisoner does not enjoy full rights of autonomy to refuse food etc., because they would then be frustrating the lawful order of a court (i.e. the order sentencing him to life imprisonment).
Thus it was held that once medical necessity has been clearly demonstrated, there is no breach of human rights in this case. In making the order compelling the defendant to undergo treatment, Justice Humphreys found that “action taken by prison management to prevent a prisoner’s life being put at risk by neglect, such as refusal of medical treatment, is not unlawful even without such relief having been granted”.
Click here for a copy of the judgement.